Geller G, Tambor E S, Chase G A, Hofman K J, Faden R R, Holtzman N A
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD.
Arch Fam Med. 1993 Nov;2(11):1119-25. doi: 10.1001/archfami.2.11.1119.
To determine, by response to a scenario, how willing primary care physicians would be to counsel a couple about prenatal diagnosis of cystic fibrosis and how directive they would be about whether the couple should undergo prenatal diagnosis and whether the couple should terminate the pregnancy if the fetus is affected.
Survey of a random sample of primary care physicians, psychiatrists, and genetics professionals in 10 geographically representative states.
Sixty-five percent (N = 1140) of 1759 obstetricians, pediatricians, internists, family practitioners, and psychiatrists, and 79% (N = 280) of medical geneticists and genetic counselors.
Respondents were evenly divided on whether they would counsel about prenatal diagnosis or refer to a genetic counselor (49.4% and 50.6%, respectively). Those who indicated that they would counsel were likely to have greater knowledge about genetics, greater confidence in communicating about genetics, and higher tolerance for ambiguity and were more likely to have completed their medical training since 1971 and to practice in a rural area. Forty-four percent of physicians would give an opinion about prenatal diagnosis. Men would be more likely to give an opinion than women (P < .005). Only 9.6% of respondents would give an opinion regarding abortion. These respondents were more likely to come from specialties with less exposure to genetics and to value attendance at religious services. Primary care physicians were more likely to give their opinions about prenatal diagnosis and abortion than genetics professionals.
To the extent that attitudes are reflected in practice, genetic counseling may be more directive when provided by primary care physicians than by genetics professionals, unless primary care physicians' growing involvement in genetics changes their attitudes.
通过对一个情景的回应，确定初级保健医生在为一对夫妇提供关于囊性纤维化产前诊断的咨询时的意愿程度，以及他们在这对夫妇是否应接受产前诊断、如果胎儿受影响这对夫妇是否应终止妊娠等问题上的指导倾向。
对10个具有地理代表性的州的初级保健医生、精神科医生和遗传学专业人员进行随机抽样调查。
1759名产科医生、儿科医生、内科医生、家庭医生和精神科医生中的65%（N = 1140），以及医学遗传学家和遗传咨询师中的79%（N = 280）。
在是否会就产前诊断提供咨询或转介给遗传咨询师的问题上，受访者意见平分秋色（分别为49.4%和50.6%）。表示会提供咨询的人可能对遗传学有更多了解，在交流遗传学问题时有更大信心，对模糊性有更高容忍度，并且更有可能自1971年以来完成医学培训并在农村地区执业。44%的医生会就产前诊断发表意见。男性比女性更有可能发表意见（P < .005）。只有9.6%的受访者会就堕胎发表意见。这些受访者更有可能来自接触遗传学较少的专业，并且重视参加宗教活动。与遗传学专业人员相比，初级保健医生更有可能就产前诊断和堕胎发表意见。
在实践中态度有所体现的程度上，除非初级保健医生对遗传学的日益参与改变他们的态度，否则由初级保健医生提供的遗传咨询可能比遗传学专业人员提供的更具指导性。
